听Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY

听

听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听听 June 01, 2017

ADMINISTRATIVE ORDER
No. 2017 鈥� 0008

SUBJECT: Implementing Guidelines of Republic Act 10754, otherwise known as 鈥淎n Act Expanding the Benefits and Privileges of Persons with Disability鈥�, for the Provision of Medical and Health-related Discounts and Special Privileges

I. RATIONALE

In the pursuit of achieving 鈥淎ll for Health towards Health for All鈥�, the Philippine Health Agenda (PHA) defines the blueprint of the government鈥檚 strategies to have an inclusive and responsive health care for all Filipinos. The PHA guarantees the provision of health services to all Filipinos especially the poor, marginalized, and vulnerable such as the persons with disabilities (PWDs). In response, the Department of Health (DOH) ensures that relevant policies and plans for the Health and Wellness Program for PWDs are crafted and implemented in accordance with the PHA and current governing laws.

The Republic Act (RA) 10754, otherwise known as 鈥淎n Act Expanding the Benefits and Privileges of Persons with Disability鈥�, was enacted into law on March 23, 2016 and its corresponding Implementing Rules and Regulations (IRR) was signed on December 1, 2016. This law expands the benefits and privileges of PWDs by amending Republic Act 7277, otherwise known as the 鈥淢agna Carta for Persons with Disabilities鈥�. In particular, Section 1 of RA 10754 amends Section 32 of RA 7277 entitling the PWDs to at least twenty percent (20%) discount and exemption from the value-added tax (VAT) on the purchase of certain goods and services from all establishments for the exclusive use, enjoyment, or availment of the PWD.

As mandated in Rule IV, Secs. 6.4 and 6.5 of the IRR of RA 10754, the DOH, in coordination with Philippine Health Insurance Corporation (PhilHealth) and Food and Drug Administration (FDA), shall issue the corresponding guidelines, circulars or directives related to the purchase of health and medical goods and availment of services from medical establishments.

In this regard, the DOH is hereby repealing DOH Administrative Order (AO) 2009-0011 to include the additional benefits and privileges stated in the RA 10754 and its IRR.

II. OBJECTIVES

To provide guidelines for the implementation of at least 20% discount and VAT exemption in all medical, and health-related services for PWDs.

III.听 SCOPE AND COVERAGE

This Administrative Order applies to all private and government hospitals and other health facilities, health care professionals, PhilHealth, pharmacies, and other establishments providing medical and health-related care and services to PWDs.

IV. DEFINITION OF TERMS

Annex A provides the relevant and pertinent definition of terms as adopted from RA 7277, RA 9442, and RA 10754.

V. GENERAL GUIDELINES

  1. All PWDs are entitled to at least 20% discount and VAT exemption upon requirements determination and compliance by both the provider/establishment and PWD.
  1. At least 20% discount and VAT exemption shall cover purchase of generic and branded medicines, medical and assistive devices, costs of medical, dental, and rehabilitation services, and diagnostics and laboratory fees, as prescribed by the attending physician for all PWDs.
  1. Diagnosis or treatment shall be in accordance to the latest Clinical Practice Guidelines (CPGs) or hospital treatment protocols, for all service wards and pay sections of government hospitals and facilities, and in all private hospitals and medical facilities.
  1. Services which are medically necessary for the prevention, diagnosis, treatment, rehabilitation, or palliation of the PWD shall be provided the discount and exemption.
  1. All PWDs shall be enjoined to become PhilHealth members (member or dependent of active PhilHealth member). The national government through the National Household Targeted System or Listahan, LGUs, NGOs, or private individual and/or group shall support the PhilHealth enrolment of non-PWD members. PWDs may also opt to enroll themselves as individual paying members.
  1. All government and private hospitals, medical facilities, and hospitals including drugstores and other licensed establishments dispensing medicines shall develop appropriate and strategic communication materials to disseminate information and policies set forth by this issuance accessible to all PWDs; designate express lanes for PWDs; and issue official receipts in every payment of drugs and medicines, medical/assistive devices, and other services stating the usual rates or fees, retail price, discounts and VAT exemption.
  1. All health facilities shall provide holistic quality care to PWDs and their families and treat them with professional conduct and respect in support of this Order.

VI. IMPLEMENTING RULES AND MECHANISM FOR THE AVAILMENT OF PRIVILEGES

  1. 听At least 20% discount and VAT exemption shall apply to the following:

a. Generic and branded medicines as well as food for special medical purposes in establishments dispensing medicines

b. Medical and assistive devices not limited to the list enumerated in Annex B. Purchase of any the following medical devices shall be recorded in the Purchase Booklet for control and monitoring:

i. Medical and assistive devices used/consumed during check-up or confinement of a PWD regardless of the number听 听 of days of stay in the hospital or any health facilities and during听 听 听 听 听 听 听 听 听 听 听recovery at home, or for monitoring of a particular ailment or disease, or to aid the maintenance of a treatment.

ii. Medical and assistive devices used during recovery at home, or for monitoring of a particular听 ailment or disease, or to aid the maintenance of a treatment, with the approval / referral of the 听 听 听 听听听听听听听听听听physician.

c. Professional fees of attending doctors in the pay section of government and private hospitals and听 facilities; and

d. Costs of medical, dental, and rehabilitation services; diagnostic and laboratory services including听 the use of听 special reagents, dyes, contrast media, and radioactive isotopes; and psychological, 听 听 听 听听听 听听behavioral, and developmental tests 鈥� for both in-patient and out-patient PWDs in government and private hospitals and facilities

  1. The hospital bed for a PWD confined in a service ward of a government facility shall be classified based on AO 51-A s. 2001 known as the Implementing Guidelines on the Classification of Patients on Availment of Medical Social Services in government health facilities. The balance shall be paid by the PWD based on his/her Medical Social Worker Classification.
  1. Discounting and computation of the 20% Discount and VAT exemption:

a. 听At least 20% discount and VAT exemption shall be granted upon full payment of the hospital bill. The billing statement showing the usual rates or fees and the discounted prices shall be 听 听 听 听听听 听听 听听听 听听听 听 听 attached to the official receipt.

b. At least 20% discount and VAT exemption shall be deducted upon purchase of the medicines and medical and/or assistive devices, with compliance to the necessary documentary 听 听 听 听听听 听听听听听 听听 听 听听听 听听听requirements for the availment of discounts and exemption.

c. All PhilHealth accredited health care institutions shall first deduct 12% VAT exemption from the total health care institution charges, then deduct the 20% PWD discount from the difference. 听 听 听 听听听 听听听听听 听听Other PhilHealth benefits shall be deducted from the remaining amount. It is only after deducting听 the appropriate discount from the total bill or statement of account that the accredited health care institution can file claim for benefit package.

d. The discount privileges and VAT exemption shall be non-transferable and exclusively for the benefit of the PWD.

e. Double discounts shall not be allowed. The PWD shall avail of the establishment鈥檚 offered discount or at least 20% discount and VAT exemption provided herein, whichever is higher and 听 听 听 听听听 听听 听more favorable. In cases where the person with disability is also a senior citizen entitled to a 20% discount and VAT exemption under his/her valid senior citizen identification card (ID), the 听 听 听 听听听 听听 听听 person with disability shall use either his/her PWD ID Card or Senior Citizen ID card to avail of the at least 20% discount and VAT exemption.

f. Drugs stores offering special discounted prices less than 20% of the regular retail price can deduct the percentage discount of their promotional campaign from the total of twenty percent 听 听 听 听听听 听听 听听听 (20%) discount as required by RA 10754. Thus, a total discount of 20% for PWD shall still be applied.

  1. Purchase of All Medicines and Medical Assistive Devices and Documentary Requirements for the Exclusive Use of the PWDs

A. The following documentary requirements shall support the availment of the discount and exemption for compliance of PWDs:

i. PWD identification (ID) card as issued by Local Government Unit (LGU) through the City/Municipal Social Welfare and Development Office (C/MSWDO) or the Persons with 听 听 听 听听听听听听听听听听听听听听 Disability Affairs Office (PDAO) of the place where the PWD resides in accordance with 麻豆传媒-Administrative Order #001. 麻豆传媒 (麻豆传媒) shall issue a 听 听 听 听听听听听听听听听听听temporary PWD ID to PWDs in emergency situations such as but not limited to hospital听 confinement, provided that the PWD ID number coding shall be retained in accordance with 听 听 听 听听听听听听听听听听听听听the official residence of the PWD.

ii. Except for over-the-counter (OTC) drugs, a doctor鈥檚 prescription shall be presented for medicines and food for special medical purposes. A prescription shall have the following 听 听 听 听听听听听听听听听听听听听听 听information: (1) name of the PWD, (2) age, (3) sex, (4) address, (5) date, (6) generic name of the medicine, (7) dosage form, (8) dosage strength, (9) quantity, (10) signature over printed 听 听 听 听听听听听听听听听听听听听 name of physician, (11) physician鈥檚 address, (12) contact number of physician or dentist, (13) professional license number, (14) professional tax receipt number and (15) narcotic license 听 听 听 听听听听听听听听听听听听 听number, if applicable. The drugstores may limit the dispensing of OTCs to not more than a week鈥檚 supply. Only prescriptions that contain the above shall be honored.

A doctor鈥檚 prescription shall also be presented for medical and assistive devices in accordance with preceding paragraph.

iii. Purchase booklet issued by the local social/health office to PWDs for free containing the听 following basic information:

    1. 听 听 听 听听听听听听听听 1.) PWD ID number

    1. 听 听 听 听听听听听听听听 2.) Booklet control number

    1. 听 听 听 听听听听听听听听 3.) Name of PWD

    1. 听 听 听 听听听听听听听听 4.) Sex

    1. 听 听 听 听听听听听听听听 5.) Address

    1. 听 听 听 听听听听听听听听 6.) Date of Birth

    1. 听 听 听 听听听听听听听听 7.) Picture

    1. 听 听 听 听听听听听听听听 8.) Signature or thumb mark of PWD

    1. 听 听 听 听听听听听听听听 9.) Information of medicine to be purchased such as name of medicine, quantity, attending physician and his/her license number, name of servicing drug store and name of 听 听 听 听听听听听听听听 听听听听听 听听听听听听听听 听听听听听dispensing pharmacist

    1. 听 听 听 听听听听听听听听 10.) Authorization letter of the PWD who is residing in the Philippines at the time of purchase, currently dated and the identification card of the authorized person or representative, in case the medicine is bought by the representative or caregiver of the PWD. Purchase booklets shall be used to record the kind of OTC medicine purchased, how many, when and where it was purchased. Likewise, this shall help the drugstores to monitor the last purchase made for a certain medicine.

    1. 听 听 听 听听听听听听听听 11.) In cases wherein the PWD is a minor or mentally or physically incapacitated to execute an authorization letter, the parent or legal guardian or representative shall be allowed to make the purchase on behalf of the PWD, upon proof of their valid identification card. The name of the said guardian or representative shall be indicated at the back of the PWD ID and shall be the exclusive representative of the PWD.

B. Establishments / Providers dispensing medicines and assistive devices

i. As a general rule, any single dispensing of medicines must be in accordance with the prescription issued by a physician and should not exceed one (1) month supply.

ii. Drug stores are required to maintain a special record book for PWD subject to inspection by the FDA and Bureau of Internal Revenue.

iii. For partial filling, the establishment鈥檚 pharmacists shall indicate the quantity partially filled in the purchase booklet (special record book) and the unfilled balanced on the prescription. The 听 听 听 听听 听听听听听听听PWD shall retain the partially filled prescription and present the same later to complete the prescribed quantity. Fully filled prescription shall be surrendered by the PWD to the 听 听 听 听听 听听听听听听听听听听听听听听听 establishment鈥檚 pharmacists.

      1. Responsibilities of Stakeholders

a. All Government Facilities shall:

i. Post hospital room rates, laboratory tests, diagnostics tests fees, medicine prices, and all other rates and fees in noticeable or strategic places in their respective facilities (e.g. near or at the 听 听 听 听 听 听 听听 main entrance of facilities); and

ii. Submit the aforementioned price list annually to the Health Facility Development Bureau of the DOH and PhilHealth; and

iii. Provide mechanisms to address queries or complaints from PWDs.

b. Private Hospitals and Medical Facilities and Establishments shall:

i. Post the price of all room rates in the Admitting Section. The prices of diagnostics and laboratory tests based on room and board accommodation, medical supplies and medicines shall be made available upon request of the PWD. The list shall ensure validation of the discount and VAT exemption granted to PWDs.

ii. Provide mechanisms to address queries or complaints from PWDs with regard to discount and VAT exemption on professional fees; and

iii. Inform in writing, copy furnished the aggrieved party, the necessary sanction 听for the health professionals 听who refuse to grant the proper discount and VAT exemption.

c. Drugstores and other licensed establishments dispensing medicines

i. Drugstores shall make available upon the PWD鈥檚 request, a generic menu card and shall receipt for drugs and medicines, which states the 听usual prices and the 听discounted prices and 听 听 听 听 听 听 听听VAT exemption of the drug or medicine.

ii. During operating hours, all licensed establishments which dispense medicines shall be prohibited from scheduling or limiting the time of the PWDs to avail the discounts.

d. Health Care Professionals shall:

i. Inscribed his/her name and PRC number in the request for diagnostic and laboratory tests, and prescription;

ii. Ensure that prescriptions 听made are for the exclusive use of the PWD to curb abuse of availing discounts for use of non-PWD citizens;

iii. Inform the PWD of the usual fees for the services required;

iv. Provide an official receipt for the rendered professional services to the PWD that states the usual fees and the discounted fees and VAT exemption.

      1. Mechanism of Endorsement of Complaints

All complaints on non-compliance with the 20% discount and VAT exemption shall be lodged with the 麻豆传媒 and/or to the respective LGU-PDAO where the purchase was made or where the PWD 听 听 听 听 听resides, whichever is convenient for the PWD in accordance with Section 15 of Rule VI of the IRR of RA 10754.

VII. SEPARATIVELY CLAUSE/REPEALING CLAUSE

This Order repeals DOH Administrative Order (AO) 2009-0011. All other issuances that are inconsistent herewith are hereby revised or modified.

If any portion or provision of this Order is declared void or unconstitutional, the remaining portions or provisions thereof shall not be affected by such declaration.

VIII. EFFECTIVITY

This Order shall take effect immediately after its publication in two (2) newspapers of general circulation.

(Original Signed)

PAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO II
Secretary of Health

ANNEX A – Definition of Terms

听As adopted from the Implementing Rules and Regulations of RA 7277, RA 9442, and RA 10754

      1. ASSISTIVE DEVICES 鈥� any device that is designed, made, or adapted to assist a person to perform a particular task or activity for daily living.
      1. CHILD WITH DISABILITY shall refer to persons below eighteen (18) years of age who have disabilities or those over but with mental capacity as that of a child and are unable to fully take care of themselves or protect themselves because of intellectual impairment, hearing impairments including deafness, speech or language impairments, visual impairments including blindness, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments or specific learning disabilities who by reason thereof need special education and other services.
      1. DISABILITY 鈥� shall mean (1) a physical or mental impairment that substantially limits one or more psychological, physiological or anatomical function of anatomical function of an individual or activities of such individual; (2) a record of such is impairment; or (3) being regarded as having such impairment.
      1. ESSENTIAL DRUG/MEDICINE 鈥� drug/medicine that satisfies the priority health care needs of the population and which is selected based on the evidence of its efficacy, safety and comparative cost effectiveness.
      1. ESSENTIAL DRUG LIST OR NATIONAL FORMULARY 鈥� a list of drugs prepared and periodically updated by the DOH on the basis of health conditions obtained in the Philippines as well as on internationally accepted criteria.
      1. ESTABLISHMENTS DISPENSING MEDICINES, MEDICAL DEVICES AND ASSISTIVE DEVICES 鈥� any drugstores, assistive device stores, government or private hospital pharmacies, medical clinics, optical clinics, audiology centers, and similar establishments dispensing medicines and selling assistive devices duly licensed or franchised by the FDA and/or the local government unit (LGU).
      1. FOODS FOR SPECIAL MEDICAL PURPOSES 鈥� category of foods for special dietary uses which are specially processed or formulated and presented for the dietary management of patients and maybe used only under medical supervision as described and define in FDA Codex STAN 180-1991. They are intended for the exclusive or partial feeding of patients with limited or impaired capacity to take, digest, absorb or metabolize ordinary foodstuffs or certain nutrients contained therein, or who have other special medically-determined nutrient requirements, whose dietary management cannot be achieved only by modification of the normal diet, by other foods for special dietary uses, or by a combination of the two.
      1. HEALTH CARE PROFESSIONAL 鈥� any licensed physician, dentist, nurse, midwife, allied medical practitioner, paramedical practitioner, or other health care professional or practitioner duly licensed to practice in the Philippines.
      1. IMPAIRMENT 鈥� any loss, diminution or aberration of psychological or physiological function with or without an accompanying anatomical structural defect.
      1. MEDICAL DEVICES 鈥� an instrument, apparatus, equipment, machine, contrivance, implant, in vitro 听reagent, or 听other similar 听or related 听article, 听including a component part, or 听accessory which is: 听(1) intended for 听use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in persons with disabilities; and 听(2) intended to affect the structure or any function of the body of PWDs, and which does 听not achieve 听any of its 听primary intended 听purposes through chemical action within or on 听the body of man or other 听animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.
      1. MEDICAL SERVICES 鈥� shall refer to the hospital room accommodation, hospital services, medical supplies, professional services of health care professionals, diagnostic services, and听laboratory 听services that are 听necessary for the prevention, diagnosis, treatment, 听rehabilitation, and 听palliation of a persons鈥� disability, illness or injury. This should not be limited to hospital services but should include clinics and other health facilities. 听听Further,听it refers 听to health services 听which include but not limited to prevention of disability through immunization, nutrition, environmental protection and preservation; genetic 听counseling; early detection of disability; and timely intervention, medical or surgical, 听to arrest 听the disabling 听 听Intervention includes rehabilitation and provision of assistive devices.
      1. MEDICALLY NECESSARY 鈥� services required to preserve and maintain the health status of a person in accordance with accepted standards of the medical practice in the medical community. This includes services which are absolutely necessary in treating a patient and which could adversely affect the patient鈥檚 condition if it were omitted.
      1. MEDICINE / DRUG 鈥� any chemical compound or biological substance, other than food, intended for use听in the 听treatment, 听prevention 听or diagnosis of disease in humans or animals, including but not limited to:

a. Any article recognized in the official United States Pharmacopoeia 鈥� National Formulary (USN-NF), official Homeopathic Pharmacopoeia of the United States, Philippine Pharmacopoeia, 听 听 听 听 听 Philippine National Formulary (PNF), British Pharmacopoeia, European Pharmacopoeia,听 Japanese Pharmacopoeia, Indian Pharmacopoeia, any national compendium or any supplement 听 听 听 听 听 to any of them;

b. Any article intended for use in diagnosis, 听cure, mitigation, 听treatment 听or prevention of disease in humans or animals. Any article other than food intended to affect the structure or any function of the human body or animals;

c. Any article intended for use as a component of any of the articles specified in clauses (a), (b)听 and (c) not including devices or their components, parts or accessories;

d. Herbal and/or traditional drugs which are articles of plant or animal origin used in folk medicine which are: 1) recognized in the PNF; 2) intended for use in the treatment 听or cure or mitigation of disease symptoms, injury or body effects听 in humans; 3) other than food, intended to affect the structure or any function of the human body; 4) in finished or ready-to-use dosage form; and听 听 听 听 听 5) intended for use as a component of any of the articles specified in items 1 to 4. For herbs to be classified under this definition, levels and amounts as well as registration status are required 听 听听 听 听 听听 听when indicated for therapeutic use; and

e. This may also include vitamins and minerals provided that these are in accordance with the听 FDA鈥檚 prevailing cut-off on vitamins and minerals classified as drug/medicine i.e. product 听the 听 听听 听 听 听听 听 听 containing more than 150% of water- soluble vitamins and more than 102% of fat soluble 听the vitamins.

      1. PERSONS WITH DISABILITY 鈥� are those suffering from restriction or different abilities, as a听听听 result of a mental, physical or sensory impairment, to perform an activity in the manner or within the range-considered normal for a human being.

ANNEX B 鈥� List of Medical and / or Assistive Devices

The medical devices includes, but not limited to the following: cane, crutches, walkers, diaper, wheelchair 听whether 听manual or 听electric-powered, 听commode 听chair, 听bed pan, body support, fracture, sock, medical support stockings, oxygen therapy unit (gauge and tank set), IV fluid and stand, 听forceps, swabs, 听hospital bed, 听walker, urine bag, bandage, hearing aid, eye glasses, intraocular 听pen injector, hot/cold pack, therapeutic massager, therapeutic mattress/pad, all prosthesis, catheter, therapeutic warmer, glucometer set including lancets and test strips, insulin syringe and needle, thermometer, blood pressure apparatus, syringe and needles, IV set, dialyzer, adhesive strip, mask, gauze, gloves, dressing, cotton, brace, and other essential medical supplies, accessories, 听kits, 听equipment 听including the 听use of 听radiation 听devices, dental and laboratory, hospital implement or apparatus and other devices for the use of persons with disability.

This also includes the purchase of eyeglasses, hearing aids, dentures, and prosthetics, artificial bone replacements like steel and which include implants, plates, rods and screws.